Provider Demographics
NPI:1285379438
Name:RELIFORD, MIQUESHA DENICE (CPT)
Entity type:Individual
Prefix:
First Name:MIQUESHA
Middle Name:DENICE
Last Name:RELIFORD
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77879-0844
Mailing Address - Country:US
Mailing Address - Phone:832-776-8006
Mailing Address - Fax:
Practice Address - Street 1:259 FLEMING ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TX
Practice Address - Zip Code:77879-4916
Practice Address - Country:US
Practice Address - Phone:832-776-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5W5X9H9246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE5W5X9H9OtherCERTIFICATION